Workers’ Compensation News Fall 2018
October 22, 2018
Delays in Payment, Even with No Ill Will Toward the Employee, Is a Violation of the Workers’ Compensation Act
In the workers’ compensation case Dorunda v. Celebrity Integrated, the employer was provided ample notice of the injured workers’ change of address and there was still a 63 day delay in payment.
Such excessive delay, especially in light of the fact that the employer had the injured workers’ correct address in its possession, justified the assessment of a 15 percent penalty against the employer for significant delay in payment of Workers’ Compensation benefits.
The Court held that the delay in payment by the employer resulted in a violation of the Pennsylvania Workers’ Compensation Act, which requires employers to make reasonable and prompt payment. Absent an abuse of discretion, the decision to award penalties, even though there was no ill will towards the injured worker, is justifiable and within the discretion of the Workers’ Compensation Judge.
What does this mean? Any time an injured worker has not received timely payment of the workers’ compensation benefits, he or she should immediately contact the claims adjuster or insurance company or if they have counsel, contact their attorney, so that a potential Penalty Petition can be filed against the employer or insurance company for a violation of the Pennsylvania Workers’ Compensation Act.
Employer’s Refusal to Approve Surgery is a Violation of Its Obligation to Provide Reasonable and Necessary Treatment
In Goetzenberger v. Home Depot U.S.A., Inc., the Workers’ Compensation Appeals Board (WCAB) held that the Workers’ Compensation Judge was correct in granting a Penalty Petition filed by an injured worker against the employer for failure to approve the injured workers’ surgery. The Employer’s refusal to authorize a scheduled surgery effectively prevented the injured worker from receiving recommended treatment.
The employer argued that the insurance company and employer were not required under the Pennsylvania Workers’ Compensation Act or case law to pre-approve any surgery or medical treatment and that under the law, the employer is only required to pay for medical treatment within 30 days after receiving the medical bills and records from a health care provider. However, the WCAB relied on a Commonwealth Court Decision that notes that an employer may not rely on the Act to refuse to authorize a scheduled surgery when it effectively prevents the Claimant from receiving recommended treatment.
The WCAB relying on the Commonwealth Court Decision held that an employer’s action of failure to authorize a scheduled surgery was a clear violation of its ongoing obligation to provide reasonable and necessary surgical and medical services imposed under the Act.
What does this means? An employer cannot simply state that it will not pre-authorize or approve a pending surgery that is related to the underlying work injury by stating that it will not pay for medical care and treatment until it receives records and bills. In this instance, a Claimant may file a Penalty Petition against the employer or insurance company for failure to do so even though the employer and insurance company rely on the Act as a defense to said Penalty Petition. The injured worker, through his or her attorney, needs to pursue these Penalty Petitions because every day that goes by without a required surgery is a day that an injured worker is in pain with limitations and unable to function.